Email Questions

Volunteer

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

Name*

Spouse's Name*

Address*

Street AddressCityStateZIP Code

Phone*

General Health*

Emergency Contact*

Phone*

Education Special Training

Occupation / Work Experience

Availability

Days Available

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours Preferred

Morning

Afternoon

Evening

Hours per week

Days per week

References

Name

Address

City

Phone

Name

Address

City

Phone

Volunteer Interests

The following are areas in which we have volunteer needs. If you do not see a specific opportunity you are looking for, please indicate your special interest or talent in the comments section below.

Maintenance/Housekeeping

mowing, trimming

outdoor maintenance/yardwork

cleaning bird aviaries

small carpentry projects

painting

cleaning/washing windows, etc.

Clerical

stuff envelopes/fold mailers

answering the phone

computer work (word processing)

general office work-copying/typing/filing

operating a calculator

Lifeline

install Lifeline units

Gift Shop

work in the gift shop

display merchandise

train gift shop volunteers

assist with seasonal open house sales

unpacking merchandise

seasonal housekeeping

transport/pick up merchandise

gift shop buying/market travel

floral arranging

Auxiliary

board member

make baked goods

make decadent desserts

make salads

make saucyjies

assist with auxiliary fundraisers

Transportation

transport supplies/equipment/specialists

provide transportation for volunteers

provide transportation for patients

Materials Management

re-supply/stock carts

Information/Wayfinding

receptionist/information desk

Senior Care

assist in feeding residents

serve snacks and refreshments

assist with activities

lead bible trivia/current events

play piano/organ

singing and lead hymn sings

crafts and decorations

one-on-one activities with residents

Hospice

hospice volunteer

Other

child care in hospital setting

assist in community garden

spanish interpreter

stock and rotate reading materials

assist with educational programs

serve food in cafeteria

cafeteria cashier

assist in the Emergency Department

sort cans/bottles

stock pop/snack machines

Terms*

I agree

I pledge to keep all staff/resident/patient/tenant information in strict confidence. I understand that any breach of this confidentiality will result in immediate dismissal.

Employment Application

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

Name*

PrefixFirstLastSuffix

Address*

Street AddressCityStateZIP Code

Telephone / Cell Phone*

Social Security #*

Email Address*

Position Desired*

Status Desired*

Where are you now employed?*

Reason for desired change:*

How were you referred to our organization?*

Did an employee refer you? Whom?

Are you related to anyone in our employ?*

What is the relationship?

Professional License No.

Type

State

Expiration Date

When would you be available to begin work?*

Education

College

Name & Location of School

College

Course of Study

College

Years Complete

College

Degree / Diploma

High

Name & Location of School

High

Course of Study

High

Years Complete

High

Degree / Diploma

Other

Name & Location of School

Other

Course of Study

Other

Years Complete

Other

Degree / Diploma

Have you ever been excluded or precluded from participation in Medicare, Medicaid, or any other Federal or State healthcare program or otherwise been debarred or prohibited from contracting with the Federal or State Government?*

Do you have a record of founded child or dependent adult abuse or have you ever been convicted of a crime, in this state or any other state? If yes, explain.*

Remarks

I hereby certify that the information contained in this application form is true and correct and I authorize representatives of this organization to contact any of my schools, employers or other references unless otherwise stated. This is to be done for the purposes of collecting information and an account of their experience with me. I realize the organization will check the Medicare Exclusion List and may request a criminal, child and dependent adult abuse record check on me.

I understand that if I am employed, any misrepresentation of the facts as stated or implied on this application form is sufficient cause for dismissal. I also understand that I will be required to successfully complete a health assessment before employment. This agreement does not bind either party for any specific period regarding employment.